A systematic review of patient and health system characteristics associated with late referral in chronic kidney disease

<p>Abstract</p> <p>Background</p> <p>To identify patient and health system characteristics associated with late referral of patients with chronic kidney disease to nephrologists.</p> <p>Methods</p> <p>MEDLINE, CENTRAL, and CINAHL were searched using the appropriate MESH terms in March 2007. Two reviewers individually and in duplicate reviewed the abstracts of 256 articles and selected 18 observational studies for inclusion. The reasons for late referral were categorized into patient or health system characteristics. Data extraction and content appraisal were done using a prespecified protocol.</p> <p>Results</p> <p>Older age, the existence of multiple comorbidities, race other than Caucasian, lack of insurance, lower socioeconomic status and educational levels were patient characteristics associated with late referral of patients with chronic kidney disease. Lack of referring physician knowledge about the appropriate timing of referral, absence of communication between referring physicians and nephrologists, and dialysis care delivered at tertiary medical centers were health system characteristics associated with late referral of patients with chronic kidney disease. Most studies identified multiple factors associated with late referral, although the relative importance and the combined effect of these factors were not systematically evaluated.</p> <p>Conclusion</p> <p>A combination of patient and health system characteristics is associated with late referral of patients with chronic kidney disease. Overall, being older, belonging to a minority group, being less educated, being uninsured, suffering from multiple comorbidities, and the lack of communication between primary care physicians and nephrologists contribute to late referral of patients with chronic kidney disease. Both primary care physicians and nephrologists need to engage in multisectoral collaborative efforts that ensure patient education and enhance physician awareness to improve the care of patients with chronic kidney disease.</p

Late-Onset Systemic Lupus Erythematosus With Lupus Nephritis in a 74-Year-Old Male: A Brief Case and Review

Rationale: Late-onset systemic lupus erythematosus (SLE) represents a specific subgroup of SLE, and although there is no strict age cut-off, 50 years is commonly used as the minimum age for disease onset. In this report, we present a case of a 74-year-old male with late-onset SLE and biopsy-proven lupus nephritis (LN). Presenting concerns of the patient: A 74-year-old male was referred to the nephrology clinic with a rapidly rising creatinine from a baseline of 60 µmol/L to 176 µmol/L. His labs showed pancytopenia, a positive antinuclear antibodies (ANA), and hypocomplementemia. Diagnoses: Renal biopsy showed focal proliferative glomerulonephritis that was immune-mediated and immunofluorescence showed C3, IgM, IgA, IgG, lambda, and C1q diffuse mesangial and glomerular basement membrane staining. Together these findings were in keeping with a diagnosis of stage III LN. Interventions: Treatment included hemodialysis and induction with pulse methylprednisone and cyclophosphamide. He was then placed on the Euro-Lupus Protocol. Outcomes: One year after the diagnosis, he was off dialysis, had no signs of fluid retention or uremia, and his creatinine had stabilized at ~ 330 µmol/L. Lessons learned: To the best of our knowledge, this case represents the oldest known biopsy-confirmed case of late-onset SLE and LN. Late-onset SLE is uncommon and often overlooked as classical symptoms such as malar rash or photosensitivity may not be present. The American College of Rheumatology (ACR) guidelines for treatment of LN can be applied to these patients but physicians should be cognizant of the fact that these patients may not tolerate immunosuppressive therapy as well as younger patients

Monitoring people using location-based social networking and its negative impact on trust: an exploratory contextual analysis of five types of friend relationships

Location based social networking (LBSN) applications are part of a new suite of social networking tools. LBSN is the convergence between location based services (LBS) and online social networking (OSN). LBSN applications offer users the ability to look up the location of another “friend” remotely using a smart phone, desktop or other device, anytime and anywhere. Users invite their friends to participate in LBSN and there is a process of consent that follows. This paper explores the potential impact of LBSN upon trust in society. It looks at the willingness of individuals to share their location data with family, friends, co-workers, the government, commercial entities and even strangers. The study used focus groups to collect data, and a qualitative approach towards analysis. The findings of the paper indicate that while most people are willing to share their real-time physical location with persons that they trust (e.g. family and close friends), they are generally reluctant to share such data with co-workers, government agencies and commercial entities. Even within the family context, people set limits to transparency depending on their personal circumstances (e.g. the parent-child relationship is quite different to the sibling relationship)

Location-based social networking: impact on trust in relationships

Location based social networking (LBSN) applications are part of a new suite of social networking tools. LBSN is the convergence between location based services (LBS) and online social networking (OSN). LBSN applications offer users the ability to look up the location of another “friend” remotely using a smart phone, desktop or other device, anytime and anywhere. Users invite their friends to participate in LBSN and there is a process of consent that follows. This paper explores the potential impact of LBSN upon trust in society. It looks at the willingness of individuals to share their location data with family, friends, co-workers, the government, commercial entities and even strangers

Flow chart showing the search, the major reason for exclusions of studies and the final number of studies included in this review

<p><b>Copyright information:</b></p><p>Taken from "A systematic review of patient and health system characteristics associated with late referral in chronic kidney disease"</p><p>http://www.biomedcentral.com/1471-2369/9/3</p><p>BMC Nephrology 2008;9():3-3.</p><p>Published online 25 Feb 2008</p><p>PMCID:PMC2291456.</p><p></p

A multinational Delphi consensus to end the COVID-19 public health threat

Despite notable scientific and medical advances, broader political, socioeconomic, and behavioural factors continue to undercut the response to the coronavirus disease 2019 (COVID-19) pandemic1,2. This Delphi study convened a diverse, multidisciplinary panel of 386 academic, health, NGO, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global public health threat. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry, and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of ragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust, and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by organisations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help bring this public health threat to an end

A multinational Delphi consensus to end the COVID-19 public health threat

Abstract Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic 1,2 . Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches 1 , while maintaining proven prevention measures using a vaccines-plus approach 2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities 3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end